Heart Murmurs

Question 1

Holosystolic, high-pitched “blowing murmur”?

Answer 1

Mitral/tricuspid regurg

Question 2

Crescendo-decrescendo systolic ejection murmur following ejection click?

Answer 2

Aortic stenosis

Question 3

Holosystolic, harsh-sounding murmur?

Answer 3

VSD

Question 4

Late systolic crescendo murmur with midsystolic click?

Answer 4

Mitral valve prolapse

Question 5

Immediate high-pitched “blowing” diastolic decrescendo murmur?

Answer 5

Aortic regurg

Question 6

Follows opening snap?

Answer 6

Mitral stenosis

Question 7

Continuous machine-like murmur?

Answer 7

PDA

Question 8

Radiates carotids and heart base?

Answer 8

Aortic stenosis

Question 9

Pulses are weak with a delayed peak (compared to heart sounds)?

Answer 9

“Pulsus parvus et tardus”–aortic stenosis

Question 10

Syncope, angina, and dyspnea on exertion?

Answer 10

Aortic stenosis is SAD

Question 11

Due to age-related calcifications?

Answer 11

Aortic stenosis

Question 12

Presents with bounding pulses, head bobbing, and wide pulse pressure?

Answer 12

Aortic regurg

Question 13

Delayed rumbling late diastolic murmur?

Answer 13

Mitral stenosis

Question 14

Murmur caused by congenital rubella or prematurity?

Answer 14

PDA

Question 15

Cause of ejection click?

Answer 15

Due to abrupt halting of valve leaflets

Question 16

Cause of midsystolic click?

Answer 16

Due to sudden tensing of chordae tendineae

Question 17

Cause of opening snap?

Answer 17

Due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips

Question 18

Most common valvular lesion?

Answer 18

Mitral valve prolapse

Question 19

Holosystolic murmurs?

Answer 19

Mitral/tricuspid regurg, VSD

Question 20

Pulmonary flow murmur and a diastolic rumble?

Answer 20

ASD

Question 21

Loudest at apex and radiates toward axilla?

Answer 21

Mitral regurg

Question 22

Loudest at tricuspid area and radiates to right sternal border?

Answer 22

Tricuspid regurg

Question 23

Site where VSD is loudest?

Answer 23

Tricuspid area

Question 24

Best site to hear MVP?

Answer 24

Apex

Question 25

Best heard at left infraclavicular area?

Answer 25

PDA

Question 26

Dicrotic/bigeminal pulses?

Answer 26

Pulse with 2 distinct peaks caused by a normal beat alternating with a premature beat

Question 27

Pulsus alternans?

Answer 27

Pulse with a beat-to-beat variation in magnitude of pulse pressure even tho it has a regular rhythm–indicates LV dysfunction

Question 28

Pulsus paradoxus?

Answer 28

Pulse that decreases with inspiration seen in tamponade or pericarditis

Question 29

Water-hammer pulse?

Answer 29

Bounding, forceful pulse assoc with aortic regurg

Question 30

How to increase intensity of right heart sounds?

Answer 30

Inspiration

Question 31

How to increase intensity of left heart sounds?

Answer 31

Expiration

Question 32

Hand grip?

Answer 32

Increase systemic vascular resistance (increases intensity of regurg murmurs, decreases intensity of stenotic murmurs)

Question 33

Valsalva?

Answer 33

Decrease venous return (decreases intensity of most murmurs)

Question 34

Rapid squatting?

Answer 34

Increase venous return, increase preload, increase afterload with prolonged squatting

Question 35

Most common cause of mitral stenosis?

Answer 35

Rheumatic fever

Question 36

VSD tx?

Answer 36

Sildenafil (for pulmonary HTN) or surgery

Question 37

Blowing murmurs?

Answer 37

1) Mitral and tricuspid regurg

2) Aortic regurg

Question 38

Harsh sounding?

Answer 38

VSD

Question 39

Rumbling?

Answer 39

Mitral stenosis

Question 40

How do you increase murmurs in MVP and hypertrophic CM?

Answer 40

1) Valsalva

2) Standing

Question 41

How do you decrease murmurs in MVP and hypertrophic CM?

Answer 41

Squatting

Question 42

Midsystolic murmur with a musical quality best heard bt apex and left sternal border?

Answer 42

Still’s murmur